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EP0864328A1 - Appareil pour l'anesthésie, l'analgésie et/ou la sédation contrÔlée - Google Patents

Appareil pour l'anesthésie, l'analgésie et/ou la sédation contrÔlée Download PDF

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Publication number
EP0864328A1
EP0864328A1 EP97113756A EP97113756A EP0864328A1 EP 0864328 A1 EP0864328 A1 EP 0864328A1 EP 97113756 A EP97113756 A EP 97113756A EP 97113756 A EP97113756 A EP 97113756A EP 0864328 A1 EP0864328 A1 EP 0864328A1
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EP
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Prior art keywords
xenon
patient
anesthesia
infusion
gas
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EP97113756A
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German (de)
English (en)
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EP0864328B1 (fr
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Michael Dr. Georgieff
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Individual
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Individual
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Priority to NZ337535A priority Critical patent/NZ337535A/en
Priority to CA002283228A priority patent/CA2283228A1/fr
Priority to AU67285/98A priority patent/AU719407B2/en
Priority to KR1019997008206A priority patent/KR20000076117A/ko
Priority to JP10076605A priority patent/JPH10248934A/ja
Publication of EP0864328A1 publication Critical patent/EP0864328A1/fr
Priority to US09/953,185 priority patent/US6511453B2/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K33/00—Medicinal preparations containing inorganic active ingredients
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A61K9/0026—Blood substitute; Oxygen transporting formulations; Plasma extender
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A61K9/0029—Parenteral nutrition; Parenteral nutrition compositions as drug carriers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
    • A61P21/02—Muscle relaxants, e.g. for tetanus or cramps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P23/00—Anaesthetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P23/00—Anaesthetics
    • A61P23/02—Local anaesthetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/04—Centrally acting analgesics, e.g. opioids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/20—Hypnotics; Sedatives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816—Joints or connectors
    • A61M16/0841—Joints or connectors for sampling
    • A61M16/085—Gas sampling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/40—Respiratory characteristics
    • A61M2230/43—Composition of exhalation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/40—Respiratory characteristics
    • A61M2230/43—Composition of exhalation
    • A61M2230/437—Composition of exhalation the anaesthetic agent concentration

Definitions

  • the invention relates to a device with which the Anesthesia, analgesia and / or sedation of a patient can be controlled.
  • Control means here that the state of a Patients (anesthetized, analgesized and / or sedated), starting from an actual state of the patient towards a required or desirable state in the shortest possible time possible periods can be changed. That means e.g. that in the case of anesthesia the conditions (1) analgesia, (2) loss of consciousness and (3) muscle relaxation in no time be achieved and that the transition from the anesthetized state in the full consciousness runs quickly and without complications. Control also means that a state once reached is kept stable over long periods (hours to days). That means even with drastically changing conditions the condition remains and it can easily be readjusted will.
  • TCI Target Controlled Infusion
  • closed circulatory systems in which the Administration of the injection anesthetic depending on controlled the depth of anesthesia actually determined (so-called closed loop anesthesia systems (CLAN)).
  • CLAN closed loop anesthesia systems
  • the object of the invention is to provide a device (or Device) by which a controlled Anesthesia, analgesia and / or sedation can be guaranteed can.
  • a device which thereby is characterized in that it is a container with a liquid Preparation containing a lipophilic noble gas in an anesthetic, contains an analgesic or sedative effective amount, and Means for the controlled delivery of the preparation to the patient having.
  • This device is used to control a time Preparation containing noble gas intravenously or artificially to one Deliver patients. Timed here means that over a predetermined period of time, for example 2 minutes or even 1 to 2 hours and over (to days), for example state required in an operation course (anesthetized, analgesized and / or sedated) exactly in each case can be controlled.
  • Another embodiment includes an infusion bag that is filled with the liquid preparation, a tube that connects to the patient, and a simple one Dispenser control. More complex designs include electronic control devices and pumps, such as for example infusion pumps.
  • the necessary settings for the infusion of a Liquid preparation containing noble gas can be used, inter alia, determine that, for example, the sequence of a Operation simulated in advance on a patient. That means at A patient is previously given a specific condition (anesthetized / analgesized / sedated) associated infusion rate / concentration certainly. Such a determination can easily be made be carried out immediately before the actual operation.
  • the invention is partly based on the surprising discovery back that with a noble gas (Kr, Ar, Xe) liquid Preparation of an anesthetized, analgesic or sedated Condition can be controlled easily.
  • a noble gas Kr, Ar, Xe
  • Xenon has proven effective in this context.
  • Xenon is a one-atom color, odor and tasteless noble gas of atomic number 54. Xenon is five times heavier than air. Natural xenon also contains Isotopes, for example isotopes 124, 126, 128, 129, 130, 131, 132, 134 and 136. There are also artificial isotopes known as well as Xenon 114, Xenon 133 and Xenon 142. These isotopes decay with half-lives that range between 1.2 seconds and about 40 days. Radioactive xenon isotopes are used by the not addressed the present invention.
  • Liquid preparations in the sense of the present invention are preparations in general that are based on a certain Lipophilia is a fat-soluble gas, such as the mentioned xenon or Krypton, can easily absorb, e.g. Emulsions.
  • a fat-soluble gas such as the mentioned xenon or Krypton
  • a xenon loading of the medical preparation of about 0.2 up to 0.3 ml xenon per ml emulsion. That means one analgesic and / or sedative effect in preparations with a xenon content of at least 0.2 ml / ml emulsion is guaranteed.
  • An anti-inflammatory effect is already observed at 0.1 ml / ml emulsion. It has been shown that 20 ml of an emulsion containing 0.3 ml of Xe per ml of emulsion with continuous infusion over 30 sec a sub-anesthetized Condition in a patient weighing approximately 85 kg.
  • an intravenous sedative or anesthetic be provided in the preparation to provide pharmacologically active agents.
  • This can for example an intravenous sedative or anesthetic be.
  • this is then in the aqueous Phase or the lipid phase next to the xenon.
  • anesthetic e.g. 1.5-20 mg / ml.
  • Etomidate in is also suitable Concentrations of 0.1 - 2 mg / ml (Hypnomidate®, an imidazole-5-carboxylic acid derivative).
  • dissolved xenon By using dissolved xenon In addition to the other anesthetic, it can be used for anesthesia necessary concentration of ex. Diisopropylphenol or Reduce etomidate to smaller values.
  • 1 ml of fat emulsion according to the invention (which about 0.1 g fat per ml Emulsion) contains 2.5 - 20 mg 2,6-diisopropylphenol, d. H. for example 2.5, 5.0, 7.5, 10, 15 or 20 mg in addition the xenon.
  • analgesic or sedative substance in addition to xenon as an anesthetic, analgesic or sedative substance more Anesthetics, analgesics, muscle relaxants or sedatives to be available.
  • Other anesthetics include Barbiturates (including barbital, phenobarbital, pentobarbital, secobarbital, Hexobarbital and thiopental) in general and opioids in Consideration.
  • Known analgesics include Type connections of morphine, e.g. Hydromorphone, oximorphone, codeine, Hydrocodon, Thebacon, Thebain, Heroin. Can continue synthetic derivatives of morphine are used, e.g.
  • Weaker analgesics can also be used They are used like anthranilic acid derivatives (flufenamic acid, Mefenamic acid), acrylic acid derivatives (diclofenac, tolmetin, Zomepirac), aryl propyl acid derivatives (ibuprofen, naproxen, Phenoprofen, ketoprofen) and indole or indenacetic acid derivatives (Indomethacin, Sulindac).
  • Central muscle relaxants are used, such as Baclofen, Carisoprodol, Chlordiazepoxid, Chlormezanon, Chloroxazone, dantrolene, diazepam, phenyramidol, meprobamate, Phenprobamate, orfenadrin).
  • Sedatives according to the invention can be used include Benzodiazepine derivatives such as Triazolam, lormetazeban, clotiazepam, flurazepam, nitrazepam, Flunitrazepam.
  • Liquids that can absorb lipophilic noble gases are e.g. Blood substitutes, including Perfluorocarbon emulsions (e.g. Perflubron®).
  • perfluorocarbon compounds have high solubility in a variety of gases.
  • a perfluorocarbon emulsion consists, for example, of up to 90% (weight / volume) perflubron (C 8 F 17 ).
  • emulsifiers for example phospholipids from egg yolk, are required. These emulsions, which can be loaded with xenon according to the invention, are described, for example, by JA Wahr et al. in Anesth. Analg. 1996, 82, 103-7.
  • Suitable fluorocarbon emulsions preferably comprise 20 w / v% to 125 w / v% of a highly fluorinated hydrocarbon compound, for example multiply fluorinated bisalkylethenes, cyclic fluorocarbon compounds such as fluoro-decalin or perfluoro-decalin, fluorinated adamantane, perfluorinated amines such as fluorinated tripropylamine and fluorinated tributylamine.
  • a highly fluorinated hydrocarbon compound for example multiply fluorinated bisalkylethenes, cyclic fluorocarbon compounds such as fluoro-decalin or perfluoro-decalin, fluorinated adamantane, perfluorinated amines such as fluorinated tripropylamine and fluorinated tributylamine.
  • Monobrominated perfluorocarbons can also be used, such as, for example, 1-bromoheptadecafluorooctane (C 8 F 17 Br), 1-bromopenta-decafluoroheptane (C 7 F 15 Br) and 1-bromotridecafluorohexane (C 6 F 13 Br).
  • ethers or polyethers for example (CF 3 ) 2 CFO (CF 2 CF 2 ) 2 OCF (CF 3 ) 2 , (CF 3 ) 2 CFO (CF 2 CF 2 ) 3 OCF 2 (CF 3 ), (CF 3 ) 2 CFO (CF 2 CF 2 ) 2 F, (CF 3 ) 2 CFO (CF 2 CF 2 ) 3 F and (C 6 F 13 ) 2 O.
  • perfluoroalkylated ethers or polyethers for example (CF 3 ) 2 CFO (CF 2 CF 2 ) 2 OCF (CF 3 ) 2 , (CF 3 ) 2 CFO (CF 2 CF 2 ) 3 OCF 2 (CF 3 ), (CF 3 ) 2 CFO (CF 2 CF 2 ) 2 F, (CF 3 ) 2 CFO (CF 2 CF 2 ) 3 F and (C 6 F 13 ) 2 O.
  • Chlorinated derivatives of the aforementioned are also Perfluorocarbons can be used.
  • the carrier capacity of the perfluorocarbon preparation mentioned above is considerable.
  • Xenon loads from 1 to 10 ml / ml achieved with the simplest of means.
  • Xenon loads from 1 to 10 ml / ml achieved with the simplest of means.
  • noble gas For example can make these preparations with noble gas by simple Pass through the gas.
  • xenon can be used in a considerable amount Can accumulate amount in a fat emulsion. So can already with the simplest means xenon in concentrations from 0.2 to 10 ml (concentrations refer to standard conditions, i.e. 20 ° C and normal pressure) and above xenon per ml fat emulsion be dissolved or dispersed.
  • concentrations from 0.2 to 10 ml (concentrations refer to standard conditions, i.e. 20 ° C and normal pressure) and above xenon per ml fat emulsion be dissolved or dispersed.
  • the xenon concentration depends depends on a variety of factors, especially concentration of the fat. As a rule, the preparations are made up to "load" the saturation limit with xenon. But it can also very low concentrations are present, for example pharmacological activity when administered intravenously can still be observed.
  • fat emulsion With a 10% fat emulsion can easily xenon concentrations of 0.3 to 2 ml Xenon can be achieved per ml of fat emulsion. Of course are also higher values, e.g. 3, 4, 5, 6 or 7 ml xenon per ml fat emulsion achievable.
  • These fat emulsions are at least sufficiently gas-tightly sealed containers so that the xenon does not reappear during normal storage periods releases as gas.
  • the lipid phase of the preparation that takes up the gas, i.e. can dissolve and / or disperse, is essentially by So-called fats are formed, which are essentially esters of long-chain and medium-chain fatty acids can act. Such fatty acids, saturated or unsaturated, contain 8 to 20 carbon atoms. In addition, omega-3 or omega-6 fatty acids are used that have up to 30 carbon atoms can contain. Offer as esterified fatty acids especially vegetable oils such as B. cottonseed oil, Soybean oil, safflower oil, fish oil and the like of these naturally occurring oils are the triglycerides of fatty acids. Preparations are of particular importance which exist as so-called oil-in-water emulsions.
  • the Fat content of the emulsion usually 5 to 30% by weight, preferably 10 to 20 wt .-%.
  • an emulsifier is present, whereby soy phosphatides, Gelatin or egg phosphatide have proven their worth.
  • Such Emulsions can be made by using water immiscible oil in the presence of the emulsifier, usually a surfactant that is emulsified in water.
  • other polar solvents such as for example Ethanol, glycerin (propylene glycol, hexylene glycol, Polyethylene glycol, glycol monoether, a water miscible Esters, etc.).
  • the noble gas can already be in one previous process step introduced into the lipid phase have been.
  • the finished emulsion with the xenon there is the to load the finished emulsion with the xenon. This can take place at different temperatures, for example at Temperatures from 1 ° C to room temperature.
  • fat emulsions such as those can be used are used in intravenous nutrition.
  • This Fat emulsions consist essentially of a suitable one Fat base (soybean oil or sunflower seed oil) and one well-tolerated emulsifier (phosphatide).
  • Commonly used Fat emulsions are Intralipid®, Intrafat®, Lipofundin®S and Liposyn®. More details on these fat emulsions can be found G. Kleinberger and H. Pamperl, Infusion Therapy, 108-117 (1983) 3.
  • the fat emulsions contain in general still additives that the osmolarity of the aqueous Phase, which is the fat phase in the form of liposomes surrounds, make blood isotonic.
  • Vitamin E DL-tocopherol
  • lipid phase especially in one Oil-in-water emulsions are so-called liposomes that result from the Triglycerides mentioned above but also generally from so-called.
  • phospholipid molecules generally consist of a water-soluble part, the is formed by at least one phosphate group, and one Lipid part, which is derived from a fatty acid or its ester derives.
  • US-A-5 334 381 explains in detail how to Can load liposomes with gas.
  • the temperature can reach up to 1 ° C can be reduced.
  • the gas gradually dissolves under pressure and gets into the liposomes.
  • When relaxing the Pressure can then form small gas bubbles come, but which are now encapsulated by the liposomes. It is therefore practically possible, for example xenon gas or other gases under hyperbaric conditions in a fat emulsion to keep.
  • Such preparations can also be used according to the invention be used as long as it is not used to train a separate gas phase outside the liposomes comes and provided that the desired pharmacological effect entry.
  • the lipids that make up the liposomes can be more natural or synthetic origin.
  • Such materials are for example cholesterol, phosphatidylcholine, phosphatidylethanolamine, Phosphatidylserine, phosphatidylglycerol, Phosphatidylinositol, sphingomyelin, glycosphingolipids, Glucolipids, glycolipids, etc.
  • the surface of the liposomes can also be modified with a polymer, for example with polyethylene glycol.
  • Control device still more measurements from one Patients (e.g. acoustically evoked potentials etc.) may include the targeted and targeted state to be able to control more precisely.
  • noble gases only come from the lungs to be eliminated by ventilation results in the intravenous administration of the preparation containing noble gas however for the first time the opportunity to measure the end-expiratory concentration of the noble gas (in particular Xenon) the actual concentration of an intravenous administerable pharmacons to determine continuously.
  • the invention thus enables a real one "Target Controlled" anesthesia. In this case there are none mathematical models for the effective plasma concentration required.
  • the invention further relates to a device for Control of anesthesia, with intravenous administration of the noble gas-containing infusion solution depending on the Noble gas concentration in the air exhaled by the patient is set.
  • the measurement of the noble gas concentration in the exhaled air can be particularly easy, especially with xenon, with a Gas detector done.
  • This device is characterized in that it is apparatus is particularly simple. It can be particularly useful in disaster medicine are used for the facilities with small space requirement are particularly advantageous.
  • This device can also be part of a system that for monitoring / controlling anesthesia with a gaseous one Anesthetic is used.
  • the invention further relates to a device for Sedation, especially analgesia, with (a) one Device that has an emulsion with a sedative Provides content of a lipophilic noble gas, (b) one Measurement data acquisition, which records measurement data from a patient, which allows conclusions to be drawn about the patient's condition, and (c) a controller that is dependent on the sensed Data the delivery of the emulsion from the facility to the Controls patient.
  • a device for (controlled) Analgesia can be used especially in the context of intensive therapy and make sense after heart surgery.
  • This Device comprises a perfuser, optionally one expiratory xenon measurement and a pulse oximeter.
  • analgesia also occurs during sedation can be.
  • the device according to the invention can be versatile use, especially in intensive therapy, endoscopy, cystoscopy, for superficial interventions and cardiac surgery.
  • the invention also relates to a device for controlled anesthesia, the concentration of the xenon in a preparation administered intravenously to a patient is, depending on the xenon concentration in the exhaled air from an anesthetized patient is regulated.
  • a device may have a mixing device in which the preparation is mixed with the xenon.
  • This mixing device can be temperature controlled (range from 1 ° C to 35 ° C. (The preparation can also be used beforehand Xenon have been loaded.) This happens, as before described, to a large extent the resolution of the xenon. in the The simplest case is the mixing device from one vessel exist through which the preparation is passed, and the Z. T. of a semipermeable permeable to xenon Membrane is surrounded.
  • the concentration of xenon in the Preparation is then essentially based on the xenon pressure the semipermeable membrane is determined.
  • the xenon gas further aids conceivable, for example active or passive stirring elements.
  • the dissolution or dispersion of xenon can also be done by ultrasound radiation improve. By simply observing the patient now the xenon concentration in during general anesthesia determine the exhaled air at which there is sufficient Anesthesia is still present. So much for the adequate depth of anesthesia can be undershot by higher xenon doses counter by means of the preparation.
  • the xenon supply via the Preparation can now be done by loading xenon and Infusion rate (using conventional infusion pumps e.g.) Taxes. In this way, it is almost a fine control of the Anesthesia is possible, as is the case with intravenous anesthetics could not be reached today.
  • the invention further relates to a device which largely corresponds to the device described above, but no addition of xenon is provided.
  • the preparation is always with xenon loaded and the anesthesia is controlled by the Infusion rate or the concentration of xenon depending from the measured expiratory xenon concentration becomes.
  • the concentration of xenon in the preparation can be reduced, for example, by another Preparation is mixed that contains no noble gas.
  • simple infusion pumps possibly peristaltic Pumping
  • a Temperature control may be provided.
  • the syringe As it is in principle according to the invention can be used.
  • the syringe the one Contains preparation containing xenon, understood as a facility that can be a preparation with an anesthetic, analgesic or sedative effective content of a lipophilic Provides noble gas.
  • FIG 2 shows a device according to the invention filled infusion bag with a regulator.
  • FIG 3 shows a device according to the invention, the one filled infusion bag with a drainage tube and has a simple controller for controlling the delivery.
  • FIG. 4 shows a further device according to the invention.
  • FIG. 5 schematically shows a device according to the invention for sedation (so-called closed-loop arrangement).
  • FIG. 6 shows a device according to the invention, the part a device for performing anesthesia with a gas and includes an inert gas measurement in the exhaled air.
  • the inventive device for performing a Controlled anesthesia is based on the schematic drawing (Fig.3) explained in more detail.
  • This device comprises a reservoir 30 for a liquid preparation, which is an inert gas in dissolved form can accommodate, and a gas container 4 for the noble gas as well a mixing device 3, in which the preparation with the Noble gas is mixed.
  • Control devices are not shown (Infusion pumps, regulators etc.) with which the intravenous addition to the patient is controlled.
  • a device according to the invention is also based on the schematic drawing (Fig.4) explained in more detail.
  • This Device can be used for controlled anesthesia where the xenon concentration is that of an anesthetized Exhaled air is analyzed analytically and in Depending on this analysis value, the xenon concentration in a preparation that is administered intravenously to the patient, is set.
  • the device consequently comprises a possibly temperature-controllable storage container 1 (temperature range 1 ° C to 35 ° C) for the preparation, via a line 5 with a again, if necessary, temperature-controlled mixing device 2 in connection stands.
  • the xenon which is from a Xenon bottle 4 via line 6, dosing control unit 2 and the further line 7 reaches the mixing device 3, mixed with the preparation.
  • the xenon comes off mostly in the emulsion.
  • the xenon-containing preparation then enters via line 8 and a venous access a patient to be anesthetized.
  • the transport of the Preparation is carried out using known (not shown) Pumping guaranteed.
  • peristaltic pumps can, for example, in the device according to the invention provided in line 5 and in addition line 8 be.
  • the end-expiratory gas sensor system is not shown and sampling.
  • FIG. 5 schematically shows a device according to the invention for sedation with a closed-loop control.
  • the device for sedation with a closed-loop control.
  • the noble gas in the exhaled air effective xenon concentration measured in the blood.
  • further measurement data are recorded by the patient (for example acoustically evoked potentials). Both measurement results are used to control the perfusion pump.
  • the measurement data are processed (for example using a computer) and into the required infusion rate implemented with which the xenon-containing Preparation reached the patient via line 8.
  • the perfusion pump is based on the recorded measurement data 21 driven, which in turn determines the infusion rate.
  • the device illustrated here is self-evident includes only a schematic and an actual device Displays and controls etc., as usually provided to, for example, manual intervention in the Allow control.
  • the supply line is not shown the perfusion pump and a reservoir over which one xenon-loaded preparation is provided.
  • This device comprises a storage container 1 for the preparation, the mixing device 2, a xenon bottle 4 and a dosing control unit 2.
  • the dosing control unit 2 is connected to a xenon detector 9, which in the end expiratory Measured air xenon concentration and one Outputs the measured value to the metering control unit 2. Via the dosing control unit 2 then the xenon is added to the controlled liquid preparation. From the mixing device 3 the xenon-containing preparation then passes through the infusion tube 8 in the patient. About the xenon concentration in the exhaled air can of course also Control infusion rate.
  • control device 40 for the Delivery of a gaseous or inhalation anesthetic available.
  • This device includes supply and discharge hoses 31 and 32 for the supply and discharge of the anesthetic gas via the inhalation mask 35.
  • an Intralipid®10 fat emulsion has the following composition: Soybean oil (3-sn-phosphatidyl) choline 100 g from egg yolk 6 g Glycerol 22.0 g Water for injections ad 1000 ml
  • an Intralipid®20 fat emulsion has the following composition: Soybean oil (3-sn-phosphatidyl) choline 200 g from egg yolk 12 g Glycerol 22.0 g Water for injections ad 1000 ml
  • the emulsions were each placed in a beaker and by passing the xenon gas through.
  • perfluorocarbon compounds perfluorohexyl octane (1), perfluorodecalin (2), perflubron (C 8 F 17 ) (3).
  • emulsifiers were used to prepare the emulsions used, for example egg yolk lecithin (Lipoid E100 from Lipoid GmbH, Ludwigshafen), Pluronic PE6800 and Pluronic F68.
  • anesthesia control here Maintenance of anesthesia, is possible according to the invention, was an examination with 24 pigs, ages 14 to 16 Weeks, weighing 36.4-43.6 kg. A total of 3 groups were randomly formed were anesthetized. Anesthesia was included in all groups a bolus injection of pentobarbitone (8 mg / kg body weight) and Buprenorphine (0.01 mg / kg body weight) administered intravenously. Anesthesia was performed in one group (comparison group) intravenous administration of 2,6-diisopropylphenol (10 mg / 1 ml Emulsion).
  • the pigs underwent surgery (standard procedure: left femoral artery separation) (identical in each group and in each test animal) and the adrenaline level, heart rate, arterial blood pressure and oxygen consumption were recorded. It was also noted which additional pentobarbitone doses were required to bring the analgesia and depth of anesthesia to the required level in each group.
  • the values given in the table show that the xenon-containing preparation currently available intravenous anesthetics is superior in particular because of the additional analgesic potency.
  • the pigs in group 1 (10% by weight fat emulsion, saturated with xenon) show significantly less stress (adrenaline level) in comparison (see comparison group), lower oxygen demand (VO 2 ) and a lower pentobarbitone requirement (i.e. better anesthesia).
  • the difference to anesthetics to be administered intravenously according to the prior art becomes even clearer if the results in group 2 (10% fat emulsion with 2,6-diisopropylphenol and enriched with xenon) are compared with the comparison group. This not only shows a significantly reduced stress (adrenaline level). With a significantly calmer heart rate and lower arterial blood pressure and lower oxygen demand, additional pentobartitone doses could be dispensed with.
  • perfluorocarbon preparations were investigated in a further group (4 pigs each weighing 31.4 to 39.8 kg body weight).
  • a 40% perfluorocarbon emulsion with a xenon content of 2.1 ml xenon per ml emulsion was used.
  • the pigs received 20 ml of the emulsion intravenously over 20 sec (this corresponds to 1.34 ml xenon / kg body weight).
  • xenon was infused intravenously continuously over 30 min.
  • the test animals received a total of 75 ml of emulsion (this corresponds to 10 ml of xenon kg -1 h -1 ).
  • Adrenaline [pg / ml] Heart rate [min -1 ] Arterial blood pressure [mm Hg] VO 2 [ml / min] 8th 90 101 301 6 87 96 320 10th 94 98 308 5 100 106 316
  • the table above shows the measurement results for the adrenaline level, the heart rate, the arterial blood pressure and the oxygen consumption.
  • the results show that with higher xenon loading and higher infusion rates (over 5 ml / kg / h), complete anesthesia can be carried out alone with the agent according to the invention.
  • VO 2 oxygen requirement
  • a stress-free anesthetic adrenaline level and heart rate

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EP97113756A 1997-03-10 1997-08-08 Appareil pour l'anesthésie, l'analgésie et/ou la sédation contrôlée Expired - Lifetime EP0864328B1 (fr)

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NZ337535A NZ337535A (en) 1997-03-10 1998-03-06 A device for controlled anaesthesia, analgesia and/or sedation using an emulsion containing inert gas
CA002283228A CA2283228A1 (fr) 1997-03-10 1998-03-06 Dispositif pour anesthesie, analgesie et/ou sedation controlees
AU67285/98A AU719407B2 (en) 1997-03-10 1998-03-06 Device for controlled anaesthesia, analgesia and/or sedation
KR1019997008206A KR20000076117A (ko) 1997-03-10 1998-03-06 마취, 진통 및/또는 진정 작용 제어장치
JP10076605A JPH10248934A (ja) 1997-03-10 1998-03-10 コントロールされた麻酔、鎮痛、鎮静のための装置
US09/953,185 US6511453B2 (en) 1997-03-10 2001-09-17 Device for controlled anaesthesia, analgesia and/or sedation

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WO2004052337A3 (fr) * 2002-12-06 2004-09-30 Michael Georgieff Preparation pharmaceutique nasale contenant un principe actif lipophile liquide ou gazeux

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DE3940389A1 (de) * 1989-12-06 1991-06-13 Abolghassem Prof Dr M Pakdaman Therapeutisches mittel
DE4100782A1 (de) * 1991-01-12 1992-07-16 Patentverwertung Dr J Haensler Waessrige ozonpraeparate, verfahren zu ihrer herstellung und ihre verwendung
EP0523315A1 (fr) * 1991-07-16 1993-01-20 Praxair Technology, Inc. Mélange de xénon, oxygène et hélium pour anesthésie
DE4411533C1 (de) * 1994-04-02 1995-04-06 Draegerwerk Ag Anästhesiegerät
WO1995027438A1 (fr) * 1994-04-08 1995-10-19 The Research Foundation Of State University Of New York Procede d'imagerie par resonance magnetique faisant intervenir des gaz rares hyperpolarises

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2000004909A3 (fr) * 1998-07-23 2000-06-22 Messer Griesheim Gmbh Agent anesthesique injectable contenant un gaz noble
WO2000027407A1 (fr) * 1998-11-09 2000-05-18 Messer Griesheim Gmbh Agent anesthesiant injectable contenant des microparticules
WO2000027406A1 (fr) * 1998-11-09 2000-05-18 Messer Griesheim Gmbh Agent anesthesiant injectable a phase hydrophile
WO2000053192A1 (fr) 1999-03-11 2000-09-14 Aga Ab Utilisation de xenon pour traiter les neurointoxications
US6559190B1 (en) 1999-03-11 2003-05-06 Aga Ab Use of xenon for treating neurointoxications
CZ302864B6 (cs) * 1999-03-11 2011-12-21 Air Products And Chemicals, Inc. Farmaceutický prostredek na bázi xenonu nebo xenonových plynových smesí pro lécení neurointoxikací
US8143317B2 (en) 1999-03-11 2012-03-27 Air Products And Chemicals, Inc. Use of xenon for treating neurointoxications
WO2002045721A1 (fr) * 2000-12-04 2002-06-13 Uws Ventures Limited Complexes a base de gaz noble
WO2004052337A3 (fr) * 2002-12-06 2004-09-30 Michael Georgieff Preparation pharmaceutique nasale contenant un principe actif lipophile liquide ou gazeux

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AU738946B2 (en) 2001-09-27
ZA981958B (en) 1999-09-09
AP1162A (en) 2003-06-30
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PT966291E (pt) 2002-03-28
KR20000076077A (ko) 2000-12-26
DE69802268T2 (de) 2002-05-16
EP0864328B1 (fr) 2003-02-19
RU2204397C2 (ru) 2003-05-20
NZ337534A (en) 2001-02-23
DE19709704A1 (de) 1998-09-24
EE9900399A (et) 2000-04-17
GR3035553T3 (en) 2001-06-29
CN1104901C (zh) 2003-04-09
TW396040B (en) 2000-07-01
ES2152608T3 (es) 2001-02-01
EP0966291B1 (fr) 2001-10-31
CA2283227A1 (fr) 1998-09-17
PT864329E (pt) 2001-03-30
EP0966291A1 (fr) 1999-12-29
US6511453B2 (en) 2003-01-28
EP0864329B1 (fr) 2000-12-13
BG103712A (en) 2000-04-28
WO1998040084A1 (fr) 1998-09-17
AU738946C (en) 2002-05-02
PL335444A1 (en) 2000-04-25
NO994091L (no) 1999-10-27
DK0966291T3 (da) 2002-02-25
KR100504287B1 (ko) 2005-07-28
HU224985B1 (en) 2006-05-29
TWI241914B (en) 2005-10-21
EP0864329A1 (fr) 1998-09-16
NO994091D0 (no) 1999-08-24
CZ292767B6 (cs) 2003-12-17
CN1255065A (zh) 2000-05-31
OA11156A (fr) 2003-04-22
ES2162437T3 (es) 2001-12-16
DE59702760D1 (de) 2001-01-18
AU6828698A (en) 1998-09-29
US6197323B1 (en) 2001-03-06
ATE198047T1 (de) 2000-12-15
ATE207754T1 (de) 2001-11-15
HK1028335A1 (en) 2001-02-16
IL131557A (en) 2004-06-20
TR199902205T2 (xx) 1999-12-21
HUP0001510A3 (en) 2000-12-28
ID23151A (id) 2000-03-23
BR9808227A (pt) 2000-05-16
DE19709704C2 (de) 1999-11-04
KR20000076117A (ko) 2000-12-26
PL189841B1 (pl) 2005-09-30
SK118799A3 (en) 2000-05-16
EE03807B1 (et) 2002-08-15
JPH10251142A (ja) 1998-09-22
US6328708B1 (en) 2001-12-11
AP9901630A0 (en) 1999-09-30
ZA981953B (en) 1999-09-09
HUP0001510A2 (hu) 2000-09-28
US20020052573A1 (en) 2002-05-02
WO1998040083A1 (fr) 1998-09-17
DE59709351D1 (de) 2003-03-27
SK284249B6 (sk) 2004-12-01
DK0864329T3 (da) 2001-04-09
DE69802268D1 (de) 2001-12-06
CZ317399A3 (cs) 2000-01-12
ATE232735T1 (de) 2003-03-15
BG64583B1 (bg) 2005-08-31

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